Laparoscopic and minimally invasive surgery has changed the surgical landscape irrevocably. NOTES (Natural Orifice Translumenal Endoscopic Surgery) offers the possibility of surgery without visible scars. Transvaginal entry offers potential benefits as access to the peritoneal cavity can be gained without the need to open an abdominal viscus. Much of the discussion pertaining to NOTES focuses on technical and training issues with little attention so far paid to the opinions of women. The perceptions of female healthcare workers, and patients were sought in relation to their views towards transvaginal NOTES.
Materials and Methods
Three hundred women were surveyed using a twelve point questionnaire devised by a multidisciplinary group of surgeons interested in minimally invasive surgery. The questionnaire was designed to establish the opinions of women with respect to NOTES surgery and its comparison to standard laparoscopic procedures. Responses were de-identified.
Three-quarters of those surveyed were neutral or unhappy at the prospect of a NOTES procedure and this remained constant even when it was stipulated that laparoscopic cholecystectomy and NOTES had equivalent safety and efficacy. Younger, nulliparous women were most concerned with the potential negative effect on sexual function. A minority were concerned with the cosmetic effect of surgery although surgical scars were perceived as more important in younger respondents.
NOTES surgery has the potential to offer women a scarless operation with the possibility of less pain than standard laparoscopic surgery. Few women were however troubled about the cosmetic effect of surgery. The effect of NOTES on sexual function was expressed as a particular concern by younger women. In all groups and across all ages peritoneal access using the transvaginal route was met by significant scepticism. In Australia, women remain to be convinced of the potential advantages of emerging NOTES technology.